Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 62-year-old woman with ovarian cancer

mksap
Conditions
June 22, 2019
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 62-year-old woman is evaluated during a follow-up visit for recently diagnosed stage IIIA high-grade serous ovarian cancer. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and completed six cycles of chemotherapy with cisplatin and paclitaxel. The patient’s paternal aunt was diagnosed with breast cancer at age 52 years. There is no personal or family history of any other cancers. She takes no medications.

On physical examination, vital signs and the remainder of the examination are normal.

Laboratory studies reveal a serum CA-125 value of 14 U/mL (14 kU/L) after chemotherapy (383 U/mL [383 kU/L] at diagnosis).

Which of the following is the most appropriate test to perform next?

A. Chest radiography annually
B. CT of the abdomen and pelvis in 3 months
C. Genetic testing for BRCA1 and BRCA2 mutations
D. Genetic testing for Lynch mutations

MKSAP Answer and Critique

The correct answer is C. Genetic testing for BRCA1 and BRCA2 mutations.

This patient should be referred to a genetic counselor for genetic testing for BRCA1 and BRCA2 mutations. Current guidelines recommend BRCA1and BRCA2 genetic testing for all women with epithelial ovarian cancer, regardless of age of onset, family history, or ancestry. Of women with ovarian cancer, 10% to 15% carry a mutation in one of these genes. Approximately 75% of epithelial ovarian cancers are serous histology—the type most likely to be associated with a BRCA1 or BRCA2 mutation. This patient has a family history of breast cancer in a paternal aunt who was age 52 years, but even with no family history of breast or ovarian cancer, BRCA1 and BRCA2 genetic testing would still be recommended. Although she had her ovaries removed, positive test results for a BRCA1 or BRCA2mutation would have implications for breast cancer risk and screening, with annual mammography and breast MRI recommended. She may also consider prophylactic mastectomies. If she carries a BRCA1 or BRCA2mutation, her siblings and children have a 50% chance of inheriting the same mutation. Genetic testing is best performed by a genetic counselor, with appropriate pre- and post-test counseling.

Routine surveillance imaging studies are not recommended for monitoring patients in clinical remission after initial treatment; therefore, neither annual chest radiography nor an abdominal-pelvic CT scan in 3 months would be recommended unless the patient develops signs or symptoms suggestive of recurrent disease.

Hereditary nonpolyposis colon cancer (HNPCC), also known as Lynch syndrome, is an autosomal dominant disorder caused by a germline mutation in one of the DNA mismatch repair genes. Patients with Lynch syndrome have a 3% to 14% lifetime risk of ovarian cancer, and the possibility of HNPCC mutation testing should be considered in patients with ovarian cancer. However, testing for HNPCC mutations is usually only offered to patients who have a personal or family history, or both, of additional HNPCC-related cancers, particularly colorectal, small bowel or endometrial cancers, or transitional cell cancers of the renal pelvis or ureters. This patient has no personal or family history of these cancers and would not usually be offered HNPCC testing based on her history of ovarian cancer alone. Models such as PREMM1,2,6 can be used to determine if a patient is eligible for HNPCC testing.

Key Point

  • Current guidelines recommend BRCA1 and BRCA2 genetic testing for all women with epithelial ovarian cancer, regardless of age of onset, family history, or ancestry.

This content is excerpted from MKSAP 18 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 18 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

Steadying patients' fears about shaking hands

June 21, 2019 Kevin 1
…
Next

When medical science becomes fake news

June 22, 2019 Kevin 5
…

Tagged as: OB/GYN, Oncology/Hematology

Post navigation

< Previous Post
Steadying patients' fears about shaking hands
Next Post >
When medical science becomes fake news

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

Related Posts

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 35-year-old woman with constipation

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 60-year-old woman with persistent constipation

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 45-year-old woman with type 2 diabetes mellitus

    mksap
  • Hormone replacement therapy is still linked to cancer

    Martha Rosenberg
  • We have a shot at preventing cervical cancer

    Lisa N. Abaid, MD, MPH
  • Obstruction of medical justice: How health care fails patients with cancer

    Miriam A. Knoll, MD

More in Conditions

  • Earwax could hold secrets to cancer, Alzheimer’s, and heart disease

    Sandra Vamos, EdD and Domenic Alaimo
  • Why male fertility needs to be part of every health conversation

    Hoag Memorial Hospital Presbyterian
  • Why health care must adapt to meet the needs of older adults with disabilities

    Lynn A. Schaefer, PhD
  • 4 traits every new attending physician needs to thrive

    Sarah Epstein
  • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

    Pearl Jones, MD
  • Why local cardiac CT scans could save your life

    Benjamin Cohen, MD
  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Recent Posts

    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • How Mark Twain would dismantle today’s flawed medical AI

      Neil Baum, MD and Mark Ibsen, MD | Tech
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Marketing as a clinician isn’t about selling. It’s about trust.

      Kara Pepper, MD | Physician
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Recent Posts

    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • How Mark Twain would dismantle today’s flawed medical AI

      Neil Baum, MD and Mark Ibsen, MD | Tech
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Marketing as a clinician isn’t about selling. It’s about trust.

      Kara Pepper, MD | Physician
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...